Task 6 - Bipolar Disorder

Question 1

Characteristics of Bipolar Disorder

Answer 1

• alternation between periods of mania and depression
• the length of an individual episode of bipolar disorder varies greatly from one person to the next
• episodes tend to be seasonal in 25% of patients

Question 2

Disruptive mood dysregulation disorder

Answer 2

= distinguishes children with temper tantrums from children with more classic bipolar disorder

• severe temper outbursts
• verbal rage and physical violence
• between outbursts –> irritable and angry mood
• 3 temper outbursts per week for at least 12 months in at least 2 lettings

Question 3

DSM-5 Criteria for a Manic Episode

Answer 3

A A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy, lasting at least 1 week and present most of the day, nearly every day

B During the period of mood disturbance and increased energy or activity, three (or more) of the following symptoms are present to a significant degree, and represent a noticeable change from usual behavior:
1. Inflated self-esteem or grandiosity
2. Decreased need for sleep
3. More talkative than usual or pressured to keep talking
4. Flight of ideas or subjective experience that thoughts are racing
5. Distractibility as reported or observed
6. Increase in goal-directed activity or psychomotor agitation
7. Excessive involvement in activities that have a high potential for painful consequences

Question 4

Bipolar I Disorder

Answer 4

Patients:
- experience mania
- eventually fall into a depressive episode; mania without depression is rare

–> the depressive episodes might be severe, or relatively mild and infrequent

Question 5

Bipolar II Disorder

Answer 5

Patients:
- experience hypomania instead of mania
–> hypomania: involves the same symptoms of mania, but the symptoms are milder
- the person also has to experience major depressive episodes

Question 6

Prevalence and Course

Answer 6

• 0.6% experience bipolar I disorder
• 0.4% experience bipolar II disorder
• onset in adolescence and early adulthood
• most people do not receive any treatment

Question 7

Comorbidity

Answer 7

• anxiety disorder
• substance abuses

Question 8

Causes: Genetic

Answer 8

• strongly linked to genetic factors
• first-degree relatives of people with bipolar disorder have 5-10 times higher rates of bipolar and depressive disorders

Question 9

Causes: Structural and Functional Brain Abnormalities

Answer 9

• abnormal function in the circuit from the prefrontal cortex through the striatum to the amygdala –> inflexible responses to rewards
  –> manic phase: excessively seek reward
  –> depressive phase: insensitive to reward
• abnormalities in the white matter of the brain
  –> prefrontal area having difficulties communicating with and exerting control over other areas
  –> disorganized emotions and extreme behavior characteristics

Question 10

Causes: Neurotransmitter

Answer 10

• high levels of dopamine are associated with reward-seeking (mania), and low levels are associated with reward insensitivity (depression)

Question 11

Causes: Psychosocial

Answer 11

• greater sensitivity to reward
• high sensitivity to punishment
• experiencing stressful events and living in an unsupportive family
• goal-striving situations might trigger high reward sensitivity
• changes in bodily rhythms or usual routines

Question 12

Treatment: Biological

Answer 12

• people tend to take antidepressants continually to prevent relapse of depression
• people tend to use mood stabilizers to relieve or prevent symptoms of mania

Question 13

Treatment: Lithium

Answer 13

• improves the functioning of the intracellular process that appears to be abnormal in mood disorders
• prevent relapses
• difference between effective and toxic dose is small
• side effects: nausea, vomiting, tremors, blurred vision, problems in concentration/attention, diabetes…

Question 14

Treatment: Anticonvulsant Medications

Answer 14

= anti-epileptic medications help stabilize mood in people with bipolar disorder
–> work by restoring the balance between the neurotransmitter systems in the amygdala

• side effects: blurred vision, fatigue, dizziness, nausea…

Question 15

Treatment: Atypical Antipsychotic

Answer 15

= quell symptoms of severe mania
–> reduce functional levels of dopamine and are especially useful in the treatment of psychotic manic symptoms

• side effects: weight gain, diabetes, insulin, glucose…

Question 16

Treatment: Interpersonal and Social Rhythm Therapy (ISRT)

Answer 16

• combines interpersonal therapy techniques with behavioral techniques to help patients maintain regular routines of eating, sleeping, and activity, and stability in personal relationships

Question 17

Treatment: Family-Focused Therapy (FFT)

Answer 17

• reduce interpersonal stress, particularly in the context of families
• patients and their families are educated about bipolar disorder and trained in communication and problem-solving skills